A new skin flap method for total auricular reconstruction in microtia patients with a reconstructed ear canal: Extended scalp and extended mastoid postauricular skin flaps

Abstract Background A skin flap is one of the most critical surgical techniques for the restoration of cutaneous defects. However, the distal necrosis of the skin flap severely restricts the clinical application of flap surgery. As there is no consensus on the treatment methods to prevent distal necrosis of skin flaps, more effective and feasible interventions to prevent skin flaps from necrosis are urgently needed. Stem therapy as a potential method to improve the survival rate of skin flaps is receiving increasing attention. Methods This review followed the recommendations from the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statements. Twenty studies with 500 animals were included by searching Web of Science, EMBASE, PubMed, and Cochrane Library databases, up until October 8, 2020. Moreover, the references of the included articles were searched manually to obtain other studies. All analyses were conducted using Review Manager V.5.3 software. Results Meta-analysis of all 20 studies demonstrated stem cell treatment has significant effects on reducing necrosis of skin flap compared with the control group (SMD: 3.20, 95% CI 2.47 to 3.93). Besides, subgroup analysis showed differences in the efficacy of stem cells in improving the survival rate of skin flaps in areas of skin flap, cell type, transplant types, and method of administration of stem cells. The meta-analysis also showed that stem cell treatment had a significant effect on increasing blood vessel density (SMD: 2.96, 95% CI 2.21 to 3.72) and increasing the expression of vascular endothelial growth factor (VEGF, SMD: 4.34, 95% CI 2.48 to 6.1). Conclusions The preclinical evidence of our systematic review indicate that stem cell-based therapy is effective for promoting early angiogenesis by up regulating VEGF and ultimately improving the survival rate of skin flap. In summary, small area skin flap, the administration method of intra-arterial injection, ASCs and MSCs, and xenogenic stem cells from humans showed more effective for the survival of animal skin flaps. In general, stem cell-based therapy may be a promising method to prevent skin flap necrosis.

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A Model for Training in Elevation of Local Skin Flaps in the Hand

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681(94)90261-5 ◽

1994 ◽

Vol 19 (6) ◽

pp. 794-795 ◽

Cited By ~ 3

Author(s):

H. D. SKOFF

Keyword(s):

Skin Flap ◽

Three Dimensional ◽

Skin Flaps ◽

Dimensional Model ◽

Surgical Experience ◽

Three Dimensional Model ◽

Local Skin ◽

Practice Models ◽

Flap Design

Appropriate skin flap design is crucial for success in surgery of the hand. Practice models are useful in acquiring surgical experience. The author describes a three-dimensional model composed of readily available materials which has been useful for practice in elevation of local skin flaps in the hand

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Vasodilator effect and mechanism of action of vascular endothelial growth factor in skin vasculature

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00901.2003 ◽

2004 ◽

Vol 286 (3) ◽

pp. H946-H954 ◽

Cited By ~ 39

Author(s):

Homa Ashrafpour ◽

Ning Huang ◽

Peter C. Neligan ◽

Christopher R. Forrest ◽

Patrick D. Addison ◽

...

Keyword(s):

Skin Flap ◽

Vegf Receptor ◽

Vascular Endothelial ◽

Skin Flaps ◽

Skin Perfusion ◽

Potent Vasodilator ◽

Or Gene ◽

Endothelial Growth Factor ◽

Endothelial Nitric Oxide ◽

First Time

Various laboratories have reported that local subcutaneous or subdermal injection of VEGF165 at the time of surgery effectively attenuated ischemic necrosis in rat skin flaps, but the mechanism was not studied and enhanced angiogenesis was implicated. In the present study, we used the clinically relevant isolated perfused 6 × 16-cm pig buttock skin flap model to 1) test our hypothesis that VEGF165 is a potent vasodilator and acute VEGF165 treatment increases skin perfusion; and 2) investigate the mechanism of VEGF165-induced skin vasorelaxation. We observed that VEGF165 (5 × 10–16–5 × 10–11 M) elicited a concentration-dependent decrease in perfusion pressure (i.e., vasorelaxation) in skin flaps preconstricted with a submaximal concentration of norepinephrine (NE), endothelin-1, or U-46619. The VEGF165-induced skin vasorelaxation was confirmed using a dermofluorometry technique for assessment of skin perfusion. The vasorelaxation potency of VEGF165 in NE-preconstricted skin flaps (pD2 = 13.57 ± 0.31) was higher ( P < 0.05) than that of acetylcholine (pD2 = 7.08 ± 0.24). Human placental factor, a specific VEGF receptor-1 agonist, did not elicit any vasorelaxation effect. However, a specific antibody to VEGF receptor-2 (1 μg/ml) or a specific VEGF receptor-2 inhibitor (5 × 10–6 M SU-1498) blocked the vasorelaxation effect of VEGF165 in NE-preconstricted skin flaps. These observations indicate that the potent vasorelaxation effect of VEGF165 in the skin vasculature is initiated by the activation of VEGF receptor-2. Furthermore, using pharmacological probes, we observed that the postreceptor signaling pathways of VEGF165-induced skin vasorelaxation involved activation of phospholipase C and protein kinase C, an increase in inositol 1,4,5-trisphosphate activity, release of the intra-cellular Ca2+ store, and synthesis/release of endothelial nitric oxide, which predominantly triggered the effector mechanism of VEGF165-induced vasorelaxation. This information provides, for the first time, an important insight into the mechanism of VEGF165 protein or gene therapy in the prevention/treatment of ischemia in skin flap surgery and skin ischemic diseases.

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Angiogenic Synergistic Effect of Adipose-Derived Stromal Cell Spheroids with Low-Level Light Therapy in a Model of Acute Skin Flap Ischemia

Cells Tissues Organs ◽

10.1159/000445710 ◽

2016 ◽

Vol 202 (5-6) ◽

pp. 307-318 ◽

Cited By ~ 8

Author(s):

In-Su Park ◽

Phil-Sang Chung ◽

Jin Chul Ahn

Keyword(s):

Growth Factors ◽

Skin Flap ◽

Light Therapy ◽

Skin Flaps ◽

Low Level Light Therapy ◽

Low Level ◽

Cell Source ◽

Hematoxylin And Eosin ◽

Recipient Tissue ◽

Regeneration Of Skin

Human adipose-derived mesenchymal stem cells (hASCs) are an attractive cell source for tissue engineering. However, one obstacle to this approach is that the transplanted hASC population can decline rapidly in the recipient tissue. The aim of this study was to investigate the effects of low-level light therapy (LLLT) on transplanted spheroid hASCs in skin flaps of mice. hASCs were cultured in monolayers or spheroids. LLLT, hASCs, spheroids and spheroids transplanted with LLLT were applied to the skin flaps. Healing of the skin flaps was assessed by gross evaluation and by hematoxylin and eosin staining and elastin van Gieson staining. Compared with the spheroid group, skin flap healing was enhanced in the spheroid + LLLT group, including the neovascularization and regeneration of skin appendages. The survival of hASCs was enhanced by decreased apoptosis of hASCs in the skin flaps of the spheroid + LLLT group. The secretion of growth factors was stimulated in the spheroid + LLLT group compared with the ASC and spheroid groups. These data suggest that LLLT was an effective biostimulator of spheroid hASCs in the skin flaps, enhancing the survival of hASCs and stimulating the secretion of growth factors.

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Evaluation of platelet-rich plasma gel as an angiogenesis-inducing agent in canineadvancement skin flaps

Pesquisa Veterinária Brasileira ◽

10.1590/1678-5150-pvb-6512 ◽

2020 ◽

Vol 40 (6) ◽

pp. 474-478

Author(s):

Grazielle A.S. Aleixo ◽

Maria C.O.C. Coelho ◽

Telga L.A. Almeida ◽

Márcia F. Pereira ◽

Miriam N. Teixeira ◽

...

Keyword(s):

Blood Vessel ◽

Skin Color ◽

Platelet Rich Plasma ◽

Skin Flap ◽

Skin Flaps ◽

Experimental Conditions ◽

Significant Difference ◽

Experimental Group ◽

Prp Gel ◽

Made In

ABSTRACT: This work aimed to evaluate the effect of platelet-rich plasma (PRP) on advancement skin flaps in dogs regarding improvement of vascularization, with focus on increasing its viable area, since there are reports that it is a potential angiogenesis stimulator. The experimental group was composed of eight adult bitches, in which two advancement skin flaps were made in the ventral abdominal region. No product was applied in the control flap (CF), while PRP was used in the contralateral flap, called treated flap (TF). The areas were clinically evaluated every two days until the 7th postoperative day regarding skin color and presence of necrosis. At 10 days, both flaps were removed and submitted to histological examination and blood vessel morphometry. The vessels counted in each group were statistically analyzed by the F-test at 1% probability. Results showed no significant difference in macroscopic changes in the wound, or CF and TF vascularization, thus suggesting that PRP gel did not improve advancement skin flap angiogenesis in bitches under the experimental conditions in which this research was developed.

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Closing Circular Defects, After Cancerous Skin Removal - 6 New Skin Flaps, and a new 5-Point Corner Suture

International Journal of Behavioural and Healthcare Research ◽

10.1504/ijbhr.2021.10040199 ◽

2021 ◽

Vol 7 (1) ◽

pp. 1

Author(s):

GEORGE SGOUROS

Keyword(s):

Skin Flaps ◽

Skin Removal ◽

New Skin

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Effects of sildenafil on the viability of random skin flaps

Acta Cirurgica Brasileira ◽

10.1590/s0102-86502011000400012 ◽

2011 ◽

Vol 26 (4) ◽

pp. 314-319 ◽

Cited By ~ 15

Author(s):

Sumara Marques Barral ◽

Ivana Duval Araujo ◽

Paula Vieira Teixeira Vidigal ◽

Cláudio Alvarenga Campos Mayrink ◽

Adriana Duval Araujo ◽

...

Keyword(s):

Wistar Rats ◽

Histological Analysis ◽

Saline Solution ◽

Skin Flap ◽

Study Group ◽

Tissue Formation ◽

Skin Flaps ◽

Dorsal Skin ◽

Macroscopic Analysis

PURPOSE: To assess the viability of McFarlane skin flaps in rats with administration of sildenafil. METHODS: Twenty Wistar rats were distributed into two groups: Control (dorsal skin flap, subdermal application of saline solution at 0.9%) and Study (dorsal skin flap, subdermal application of sildenafil). Seven days after the surgery, flaps were photographed and graphically rendered. Then, they were analyzed with AutoCAD software. Three biopsies (proximal, medial and distal) of each flap were collected for histological analysis. RESULTS: Macroscopic analysis showed that animals of the study group had greater necrotic areas (p=0.003) in the dorsal skin flaps. Additionally, histological analysis of the distal third of these flaps showed a tendency to less granulated tissue formation in animals treated with sildenafil. CONCLUSION: Sildenafil subdermally was associated with lower viability of the random skin flap in rats.

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Bilateral axillary skin fold flaps used for dorsal thoracic skin wound closure in a dog : clinical communication

Journal of the South African Veterinary Association ◽

10.4102/jsava.v81i1.98 ◽

2010 ◽

Vol 81 (1) ◽

Author(s):

B. G. Nevill

Keyword(s):

Skin Flap ◽

Skin Wound ◽

Clinical Report ◽

Skin Defect ◽

Skin Flaps ◽

Clinical Communication ◽

Dorsal Midline ◽

Skin Fold ◽

Flap Procedure ◽

Chronic Skin

A 10-year-old greyhound-cross dog was presented with a large, chronic skin wound extending over the interscapular region. The substantial skin defect was closed by making use of bilateral axillary skin fold flaps. It was possible to elevate the 2 skin flaps sufficiently to allow them to meet at the dorsal midline and thus facilitate complete closure of a large and awkwardly positioned wound. Small dorsal areas of the skin flaps underwent necrosis, but the resulting defects were closed without difficulty in a subsequent procedure. To the author's knowledge, this is the 1st clinical report of the use of bilateral axillary skin fold flaps in this fashion and describes an additional use of a versatile skin flap procedure.

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